95
Service Form
Newport Corporation
U.S.A. Office: 714/863-3144
FAX: 714/253-1800
Name
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RETURN AUTHORIZATION #
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Company
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(Please obtain prior to return of item)
Address
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Country
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Date
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P.O. Number
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Phone Number
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Item(s) Being Returned:
Model #
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Serial #
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Description
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Reason for return of goods (please list any specific problems)
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List all control settings and describe problem
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(Attach additional sheets as necessary).
Show a block diagram of your measurement system including all instruments connected (whether power is turned
on or not). Describe signal source. If source is a laser, describe output mode, peak power, pulse width, repetition
rate and energy density.
Where is the Measurement Being Performed?
(factory, controlled laboratory, out-of-doors, etc.)
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What power line voltage is used?
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Variation?
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Frequency?
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Ambient Temperature?
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Variation?
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°
F. Rel. Humidity?
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Other?
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Any additional information. (If special modifications have been made by the user, please describe below).
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